Methods for repairing cartilage defects

Abstract

The present disclosure describes methods for repairing cartilage defects by arthroscopic surgery to deliver cultured chondrocyte implants to defect sites. The implants may include bioresorbable matrices seeded with chondrocytes that are shaped to match cartilage defect sites, and which may be delivered to the cartilage defect sites by methods described in the present embodiments.

1 . An arthroscopic surgical method comprising:
 making at least two incisions in a subject adjacent to a defect to be treated arthroscopically, the at least two incisions comprising a first incision and a second incision;   inserting a first cannula into the first incision;   preparing a site of the defect to be treated at a joint in the subject;   shaping a template material to match a shape of the prepared defect site to form a shaped template material;   shaping a cell-seeded matrix to match a shape of the shaped template material by placing the cell-seeded matrix on top of the template material with the cells facing up and cutting the cell-seeded matrix to match the shape of the shaped template material;   delivering the cell-seeded matrix to the prepared defect site through the first cannula; and   fixating the delivered cell-seeded matrix using a glue.   
     
     
         2 . The method of  claim 1 , wherein the defect comprises a cartilage defect, and wherein the joint is one of a knee, an ankle, an elbow, a shoulder, a hip, or a wrist of the subject. 
     
     
         3 . The method of  claim 1 , wherein preparing the defect site comprises:
 flushing the defect site;   assessing and/or measuring the defect site;   outlining the defect site;   sculpting the defect site to remove damaged tissue; and   debriding the cartilage down to subchondral bone.   
     
     
         4 . The method of  claim 1 , wherein the template material comprises at least one member of the group consisting of sterile aluminum foil, sterile paper, and an Esmarch bandage. 
     
     
         5 . The method of  claim 1 , wherein shaping the template material comprises:
 (a) passing the template material through the first cannula inserted at the first incision;   (b) observing the template material adjacent to the defect site;   (c) removing the template material from the first cannula and cutting it to approximate the size and/or shape of the defect site based on the observations; and   (d) repeating steps (a)-(c) until the template material matches the size and/or shape of the defect site.   
     
     
         6 . The method of  claim 1 , wherein the cell-seeded matrix comprises at least one of a bioresorbable material and collagen to form a matrix, and
 wherein the cells are seeded on a surface of the matrix at a concentration of at least 250,000 cells/cm 2 .   
     
     
         7 . The method of  claim 1 , wherein the cells comprise chondrocytes. 
     
     
         8 . The method of  claim 1 , wherein the cells comprise at least one of cells autologous to the subject and allogeneic cells. 
     
     
         9 . The method of  claim 1 , wherein delivering the cell-seeded matrix comprises:
 grasping the cell-seeded matrix using a surgical grasper;   bringing the unseeded surface of the cell-seeded matrix into contact with a proximal opening of the first cannula inserted into the first incision;   pushing the cell-seeded matrix into a lumen of the cannula; and   using the surgical grasper to push the cell-seeded matrix through to a distal end of the cannula.   
     
     
         10 . The method of  claim 1 , wherein delivering the cell-seeded matrix comprises:
 folding the cell-seeded matrix in half;   grasping the folded cell-seeded matrix using a surgical grasper;   bringing the folded cell-seeded matrix into contact with a proximal opening of the first cannula inserted at the first incision;   pushing the folded cell-seeded matrix into a lumen of the first cannula inserted at the first incision; and   using the surgical grasper to push the folded cell-seeded matrix through to a distal end of the cannula.   
     
     
         11 . The method of  claim 1 , wherein delivering the cell-seeded matrix comprises:
 prior to inserting the first cannula into the first incision, disposing a surgical tool in a lumen of the first cannula such that jaws of the surgical tool protrude from a distal end of the first cannula and a handle of the surgical tool protrude from a proximal opening of the first cannula;   grasping the cell-seeded matrix using the jaws of the surgical tool;   pulling the cell-seeded matrix into the distal end of the first cannula using the surgical tool such that the cell-seeded surface faces a lumen of the first cannula and the cell-seeded matrix is partially folded;   inserting the first cannula into the first incision while the cell-seeded matrix and surgical tool are disposed within the lumen of the first cannula; and   using the surgical tool to push the cell-seeded matrix out of the distal end of the first cannula such that the cell-seeded matrix unfolds.   
     
     
         12 . The method of  claim 11 , wherein inserting the first cannula comprises inserting the first cannula into a third cannula that has previously been inserted into the first incision. 
     
     
         13 . The method of  claim 1 , wherein each cannula comprises an inner diameter in a range from about 5 mm to about 20 mm and a length in a range from about 20 mm to about 240 mm. 
     
     
         14 . The method of  claim 1 , wherein an area of the defect and the area of the cell-seeded matrix after shaping are between about 1 cm 2  and about 10 cm 2 . 
     
     
         15 . A surgical kit comprising:
 two or more cannulas;   a cell-seeded matrix comprising a bioresorbable support matrix and a plurality of cells seeded on a surface of the bioresorbable support matrix at a concentration of at least 250,000 cells/cm 2 ;   a surgical grasper;   a templating material;   one or more tools for shaping the template material and the cell-seeded matrix;   one or more tools for outlining, cutting, and debriding cartilage.   
     
     
         16 . The kit of  claim 15 , wherein the two or more cannulas each comprise an inner diameter in a range from about 5 mm to about 20 mm and a length in a range from about 20 mm to about 240 mm. 
     
     
         17 . The kit of  claim 15 , wherein the surgical grasper comprises a shaft and jaws, wherein the jaws comprise atraumatic jaws. 
     
     
         18 . The kit of  claim 15 , wherein the one or more tools for shaping comprise members selected from the group consisting of scissors, razor blades, scalpels, custom cutters, cutting blocks, surgical mallets, ring curettes, tweezers, and cutting needles. 
     
     
         19 . The kit of  claim 15 , wherein the one or more tools for shaping comprise custom cutters with blades shaped as a circle or an oval. 
     
     
         20 . A custom surgical device comprising:
 a handle;   an adjustable knob rotatably coupled to a proximal end of the handle;   a shaft coupled to the distal end of the handle;   a movable joint coupled to the distal end of the shaft; and   an adjustable distal end coupled to the moveable joint,   wherein rotating the adjustable knob causes the adjustable distal end to rotate about the moveable joint such that an angle between the adjustable distal end and the shaft changes.   
     
     
         21 .- 24 . (canceled)